Eighton Lodge Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during the inspection. Eighton Lodge Residential Care Home provides personal care and accommodation for up to 47 older people, including people with dementia-related conditions. At the time of our inspection there were 36 people using the service.

The inspection took place on 21 November 2017 and was unannounced. This meant staff did not know we were visiting.

We last inspected Eighton Lodge on 10 and 11 October 2016 and rated the service as Requires Improvement. At this inspection we found the service had improved to Good.

The service had a registered manager who was on duty during the course of our visit. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we found breaches of regulations in relation to building work hazards and risks in relation to cleaning products being securely stored. The provider sent us an action plan telling us when and how these issues had been addressed. We saw these requirements had now been met.

Staff and the management team understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding adults. People and relatives we spoke with told us they felt safe at the home.

Where potential risks had been identified an assessment had been completed to keep people as safe as possible. Health and safety checks were completed and procedures were in place to deal with emergency situations.

The home was clean, and we saw staff followed good practice in relation to wearing personal protective equipment when providing people with care and support. The environment had been extensively refurbished since our last visit and people told us they liked the décor.

Medicines were managed safely. We saw medicines being administered to people in a safe and caring way. People confirmed they received their medicines at the correct time and they were always made available to them. We saw nursing staff working with community professionals to ensure end of life anticipatory medicines were available to people when needed.

We found there were sufficient care staff deployed to provide people’s care in a timely manner. We saw that recruitment checks were carried out to ensure that staff were suitable to work with vulnerable people.

The registered manager shared learning from feedback and safeguarding events with the staff team through recorded meetings. From previous inspection visits by CQC and the local authority in 2016, the registered manager showed us their completed action plan and a recent local authority inspection visit in 2017 had given positive feedback. This showed the service had addressed areas for improvement.

Staff received the support and training they required. Records confirmed training, supervisions and appraisals were up to date. Staff told us they were supported by the home’s management, especially the team leaders.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People gave positive feedback about the meals they were served at the home. They received the support they needed with eating and drinking by the staff team and we observed people being given choices, using small plates with the meal choices on instead of just a written menu.

We saw people’s healthcare needs were well monitored and records in relation to the monitoring of people’s healt

The inspection took place on 10 and 11 October 2016 and was unannounced. We had last inspected Eighton Lodge Residential Care Home in February 2015 and found breaches of legal requirements in relation to managing medicines and training for staff. At this inspection we found the provider had made improvements in these areas, though the medicines arrangements had not been closely monitored.

Eighton Lodge Residential Care Home provides personal care and accommodation for up to 47 older people, including people with dementia-related conditions. At the time of our inspection there were 34 people living at the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found there were hazards resulting from work being carried out in the building which compromised people’s safety. These hazards had not been recognised and no efforts were made to control the risks until we brought them to the attention of the management. We highlighted further potential risks including a lack of diligence in making sure domestic equipment, and in one instance a cleaning chemical, were safely stored to prevent the likelihood of harm occurring.

There were established processes for protecting people from abuse and responding to any safeguarding concerns. Risks to people’s welfare had been assessed and measures were in place to safely provide individual care and support.

Any new staff were properly checked and vetted before they started working at the home. Sufficient staff were employed to ensure people were provided with consistent care and staffing levels were kept under review. Training provision had been improved to equip staff with the necessary skills to care for people effectively. Regular supervision and annual appraisals were carried out to assess performance and support staff in their personal development.

People were supported to access healthcare services to maintain their health and well-being. A varied diet was offered to aid good nutrition and when necessary, dietetic advice was obtained. People told us they enjoyed the food. We have made a recommendation about the way staff are deployed at mealtimes to make sure people are properly supervised.

People’s rights under mental capacity law were protected and formal processes were undertaken when people were unable to make important decisions about their care. People and their representatives were consulted about care and treatment and advocacy services could be arranged if needed.

Staff sought permission before providing support and encouraged people to make choices in their daily living. They were caring in their approach and respected people’s privacy and dignity. People and their relatives spoke highly of the care provided. There was a clear complaints procedure in place if anyone was unhappy with the service they received.

Care was appropriately planned, tailored to people’s individual needs and preferences, and adapted in response to any changes. People were offered a good range of social activities, entertainment and opportunities to out into the local and wider community.

The service had a registered manager who was supported in their role and provided leadership to the staff. Methods of seeking feedback about the service were being improved upon. Systems for monitoring standards in the home had not identified the shortfalls we found during the inspection. The quality and safety of the service needed to be kept under closer scrutiny.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the safety and governance of the service. You can see what action we told the provid

We found the provider had made progress to improve the quality of people's care records. We saw that risk assessments were reviewed in a timely manner and we also saw evidence of action taken to respond to changes in people's needs. The provider had introduced a more robust medication audit to identify and address gaps in medication records.

Staff asked people for permission before delivering care. We found people were encouraged to make choices every day and family members told us staff adhered to people's care plans. The provider had systems in place where there was a doubt about a person's capacity to make decisions.

People had their needs assessed and this information was used to develop personalised care plans. Family members gave very positive feedback about both their relative's care and the care staff. One family member commented, "Staff look competent and know what they are doing."

We found the provider had systems in place to ensure people received the medication they needed. Medication was administered by senior staff who had completed relevant training.

The provider had effective recruitment and selection procedures in place. Relatives and carers told us they were happy with the care that staff provided. One relative commented, “Staff are excellent, we have no concerns with the staff.”

People and their relatives knew how to complain and were happy with the care they received. One family member commented, “Excellent care, it’s like a five star hotel, no faults at all.” Relatives told us they knew how to complain and would have no problem complaining if they needed to.

We found some care records including care plans were incomplete and inaccurate and had not been updated in a timely manner.

We spoke to five people who used the service and they told us that the service they received was ‘very good’ and that there were ‘no complaints’.

They said that the care workers were ‘all very pleasant’ and they were ‘on very good terms’.

We were told that the food within the home was ‘very good’ and that they ‘enjoyed the atmosphere throughout’.

People who used the service said they ‘definitely feel safe’ and that they ‘knew who to complain to, if there was anything’.

People spoken to had access to their care plan and we were told that any changes in their care had been discussed with them.

We also spoke to relatives of people who used the service and they told us that the environment was ‘OK and very clean’, there are ‘things going on, such as trips out’, the ‘staff treat residents well’, and there is ‘no problem in raising issues’.

People using the service, their relatives and a visiting professional were overwhelmingly positive when speaking to us about staff, and the care provided at the home. Comments from people using the service included “It’s 100%, I’m very happy living here”, “The staff are so nice” and “Everything is lovely and everyone is nice”.

Comments from visiting relatives included “I love it for my mam, I’m very pleased with it, she is settled” and “When I walked into here, it felt right”.

A visiting professional told us the home was “a pleasure to look after”.

This inspection took place over two days, 26 and 27 February 2015. The first day of the inspection was unannounced. We last inspected Eighton Lodge Residential Care Home in November 2013. At that inspection we found the service was meeting the regulation we inspected.

Eighton Lodge Residential Care Home provides personal care and accommodation for up to 47 people, including people living with dementia. At the time of the inspection there were 46 people living at the service.

The home did not have a registered manager, as the manager in post was awaiting the outcome of her application for her CQC registration. Following our inspection, the manager received her CQC registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People’s medicines were not always stored securely and we found some medicines records were inaccurate and not always complete. The service’s arrangements for the management of medicines did not protect people.

Staff recruitment practices at the home did not always ensure that appropriate recruitment checks were carried out to determine the suitability of individuals to work with vulnerable adults, placing service users at risk of harm. Satisfactory reference checks had not been conducted and information on an application for employment form was incomplete. We saw security checks had been made with the Disclosure and Barring Service (DBS). These checks help employers make safer recruitment decisions and prevent unsuitable persons working with vulnerable people.

Staff were attentive when assisting people and they responded promptly and kindly to requests for help. People living at the home had risk assessments in place to ensure risks were identified and appropriately managed.

There were enough staff to meet people’s needs. Detailed procedures and information was available for staff in the event of an emergency at the home.

Staff understood what abuse was and knew how to report abuse if required. The service had a whistleblowing procedure which meant staff could report any risks or concerns about practice in confidence with the provider.

People using the service told us they were well cared for and felt safe with the staff who provided their care and support.

All the relatives we spoke with were positive about the standards of cleanliness in the home. A relative told us, “It’s a nice home; always clean.”

We found there were gaps in the provision of training for all staff. This meant people were at risk of unsafe working practice from staff who did not have the skills and knowledge to consistently meet their needs.

Staff received regular supervision and annual appraisals were carried out. All new staff received appropriate induction training and were supported in their professional development. Staff told us they felt equipped and supported to carry out their roles.

The provider had a Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) policy and detailed information was available for staff. The requirements of MCA were followed and DoLS were appropriately applied to make sure people were not restricted unnecessarily, unless it was in their best interest.

People were supported to keep up to date with regular healthcare appointments, such as GP’s, dentists, nurses and other primary care services.

People were supported to make sure they had enough to eat and drink. They told us they enjoyed the food prepared at the home and had a choice about what they ate.

People told us that staff treated them well and we observed kind and caring interactions between staff and people using the service.

Staff acted in a professional and friendly manner and treated people with dignity and respect. We observed staff supporting people and promoting their dignity wherever possible.

Meetings for people using the home and their relatives were held to enable them to express their views about the service. Advocacy information was accessible to people and their relatives.

Care plans were regularly reviewed and evaluated. They contained up to date and accurate information about people’s needs and risks associated with their care. Family members we spoke with said they had been involved in care planning and told us there was good communication within the home. People we spoke with told us they saw health professionals when they needed to and a G.P. from a local practice visited the home every Friday to conduct people’s reviews.

A complaints policy and procedure was in place. People told us that they felt able to raise any issues or concerns. However, we found the provider’s policy was not always followed.

The home employed a full-time activities co-ordinator. People and their relatives were complimentary about the range of activities available and how people were engaged and stimulated at the home.

The service had a manager who spoke positively and enthusiastically about her role. She told us she was keen to develop her role and help ensure people continually received good quality care and support.

Management regularly checked and audited the quality of service provided and made sure people were satisfied with the service, care and support they received.

Care staff told us the management team were approachable and supportive. We received positive feedback from people, their relatives and staff about the management team and how the service was managed and run. Staff meetings were held regularly.

During our inspection we identified a breach in two regulations. You can see what action we told the provider to take at the back of the full version of this report.